Synchronous primary malignancy of ovary and cervix with different histopathology: A rare case report

Concurrent different histopathological types of gynecologic tumors arise rarely. We present ovarian serous and cervical squamous cell carcinoma formed synchronously. A 51-year-old woman with a poor general condition was admitted with gradual distension of abdomen for 1 year with gradual loss of weight and appetite for the last three months and pain in the abdomen and irregular vaginal bleeding for the last two months. There was no family history of malignancy of genital tract, breast or colon. On examination she was cachexic, pale, dehydrated, tachypnoeic and had edema over feet. Per abdomen examination revealed solid, non-mobile palpable mass arising from pelvis. Per vaginal examination revealed large mass in pelvis and uterus can not be felt separately on per speculum examination there was small endocervical erosion, hypertrophied cervix. On per rectal examination bilateral parametria were free. Her tumor marker were evaluated and CA-125 was found to be raised (CA 125: 915.6 u/ml U/mL); rest tumor markers were normal. Cervical punch biopsy was suggestive of moderately differentiated carcinoma and pap smear was also suggestive of cervical cancer. MRI findings revealed a mass of altered signal intensity 2.5 × 1.5 × 2.2 cm with diffusion restriction and post contrast enhancement in the anterior lip of cervix and another large, lobulated predominantly solid mass, hypo intense on T1, intermediate on T2 with diffusion restriction and post contrast enhancement in the right adnexal region abutting the small bowel and sigmoid colon optimal debulking surgery with standard protocol was done. Histopathology report revealed squamous cell carcinoma of cervix, grade III and high grade serous cystadenocarcinoma of ovary. Tumour deposits from ovary were seen on right fallopian tube and right parametrium. Squamous cell carcinoma cervix involved ectocervix, endocervix and infiltrated near full thickness of cervical stroma, endomyometrium, vaginal cuff, paracervical tissue omentum and appendix were free of tumour. Twenty five right pelvic lymphnodes dissected were free of tumour, (00/25). One out of fifteen lymphnode dissected were involved with extra capsular extent, 01/15 and thirteen para aortic lymph node dissected were free of tumor. Immunohistochemistry markers: Ovarian mass-tumour cell expressed ck, vimentin, wt-1 with focal Ck positivity, no expression of ck20, p63, ck5/6 and CEA seen. Cervical tumour-tumour cells expressed ck, ck7, p63 and ck5/6 no expression of ck20, wt-1. Based on our case report we need to keep in mind that even if patient presents with symptoms pertaining to a single malignancy; still the rare possibility of synchronous malignancies should be looked for by doing proper investigations. In our case, patient had symptoms pertaining to ovarian malignancy; whereas cervical malignancy was diagnosed after investigating the patient. Histologic examination should be done properly as the prognosis depends on the malignancies being metastatic or synchronous one appropriate management should be offered in all such cases. Long term follow up of such patients should be maintained to determine the prognosis.